How should endocrinologists diagnose and treat non-alcoholic fatty liver disease?

Nonalcoholic fatty liver disease (NAFLD ) was first described in 1980 in a report from the Mayo clinic that described the characteristics of NAFLD in 20 patients1. In 1980, a liver biopsy was required to establish the diagnosis and it was noted that ‘the biopsy specimens were characterized by the presence of striking fatty changes with evidence of lobular hepatitis, focal necroses with mixed inflammatory infiltrates; and evidence of fibrosis was found in most specimens’. Additionally, most of the patients were moderately obese, and many had type 2 diabetes mellitus (T2DM) and cholelithiasis1. The report concluded ‘currently, we know of no effective therapy’1. Forty years later, it is gratifying to note that whilst there are still areas of uncertainty, there has been considerable progress in our understanding of the aetiology and pathogenesis of NAFLD, the non-invasive diagnosis of NAFLD, and how NAFLD can be treated. Moreover, in contrast to 40 years ago, there is now little need to resort to invasive, expensive and potentially risky liver biopsies to diagnose NAFLD, and there are now licensed treatments for the management of T2DM and obesity that are of proven benefit in the treatment of NAFLD.